Key result
A peak heart rate ≤75% of maximum predicted identified moderate-to-severe exercise impairment with 72% sensitivity and 73% specificity (AUC 77.2%) in patients with amyloid cardiomyopathy.
Why the study?
Little evidence is available regarding heart rate response to exercise and its relationship with functional capacity in amyloid cardiomyopathy.
Cohort (n=172)
Yes
Chronotropic incompetence is prevalent in amyloid cardiomyopathy, and a peak heart rate ≤75% of predicted can accurately identify significant exercise impairment.
Chronotropic incompetence may limit exercise capacity in amyloid cardiomyopathy; leaves open its prognostic value and management implications.
BACKGROUND: Little evidence is available about heart rate (HR) response to exercise as well as its relationship with functional capacity in amyloid cardiomyopathy. Then, in a multicentre cohort of patients with amyloid cardiomyopathy, we investigated the prevalence of chronotropic incompetence (CI) and its relationships with cardiopulmonary exercise testing (CPET) variables. METHODS: Data from 172 outpatients with amyloid cardiomyopathy who performed a maximal CPET and who had no significant rhythm disorders were analysed. RESULTS: ), either as expressed as a percentage of the maximum predicted or as mL/kg/min (p<0.001). Although to a lesser extent, pHR% correlated inversely with ventilatory efficiency (p<0.001). A pHR%≤75% resulted in the most accurate cut-off value in identifying a moderate-to-severe exercise impairment (sensitivity 72%; specificity 73%; area under the curve 77.2%). CONCLUSIONS: CI is prevalent in patients with amyloid cardiomyopathy in sinus rhythm, its percentage varying according to the pHR% cut-off value. A blunted exercise-induced HR response correlated with a poor exercise capacity even in this setting of patients, a pHR%≤75% cut-off value being possibly useful in centres without CPET availability to identify a significant exercise impairment.
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Magrì et al. (2024) conducted a cohort in amyloid cardiomyopathy (n=172). Chronotropic incompetence was evaluated on moderate-to-severe exercise impairment. A peak heart rate ≤75% of maximum predicted identified moderate-to-severe exercise impairment with 72% sensitivity and 73% specificity (AUC 77.2%) in patients with amyloid cardiomyopathy.
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